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The care that the patient should take even after “recovery”.

Mariana Alvim -marianaalvim – from BBC News Brazil in Sao Paulo

Posted on 04/25/2021 17:52

“Long Covid”, “Continuous Covid”, “Post-acute Covid-19” or “Post-Covid Syndrome” are some of the names for which a group of remnants of the disease caused by the new Corona virus or new health problems have been named weeks or months may pass after The acute phase of Covid-19 – When the viral reproduction is most active, it usually results in positive tests and symptoms typical of that stage, such as fever and a dry cough.

The United States Center for Disease Control and Prevention (CDC, Public Health Agency) has determined that it prefers the term “post-Covid cases,” which consist of health problems that appear four weeks after the first infection.

A study that followed 1,733 people for six months after contracting the COVID-19 virus in Wuhan, China, showed the majority (76%) reported at least one symptom in the post-acute period. Fatigue and muscle weakness were most frequently reported (63%). Difficulty sleeping (26%). Anxiety and depression (23%).

In addition to frequent symptoms of neuropsychiatric background, authorities also warn of the dire consequences of COVID-19 in the lung and heart.

So, after dealing with the acute phase, how can a person watch for disease consequences? BBC News consulted doctors, scientific research, and recommendations from authorities for a response, based on what is known about the disease today.

Examinations when there are signs

Respondents stated that infection with COVID-19 alone in general should not stimulate a rush for further testing and medical advice, especially given the need for social isolation – unless there are bothersome and persistent symptoms.

Most cases of Covid-19 affect only the airways (such as the nose and throat), and there are many cases that are asymptomatic or outpatient only (where less risky care is provided). covid-19, there is no need for it to be monitored routinely (by doctors), “says infectious disease specialist Moacyr Silva Junior, of Israelita Albert Einstein Hospital.

Silva Junior says the practice at his hospital is to get face-to-face checks, about seven to ten days after discharge, only for people who have been hospitalized.

“The cases that need more attention are those that are hospitalized. After days, we do routine checks, like blood,” he explains, explaining that the team is looking for blood tests to indicate kidney and liver cells, clotting and normalizing the defense system, among others.

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In January, in a new issue of its recommendations on medical practice involving the Coronavirus, the World Health Organization (WHO) included a chapter dedicated solely to caring for patients after acute illness, arguing that “the search for severe long-term consequences of Covid-19 from Priorities. “

In the publication, the World Health Organization confirmed that “patients admitted to intensive care units have a higher prevalence of symptoms in nearly all areas” than persistent covid-19. Neuropsychiatric symptoms are excluded from the relationship between acute disease severity and subsequent effects, as will be detailed below.

A man on a stretcher is full of devices around him

Nelson Almeida / AFP via Getty Images
“ Patients admitted to intensive care units have a higher prevalence of symptoms in nearly all areas, ” the WHO publication says.

But the organization recognizes in the post that regardless of the severity of the acute illness, anyone with COVID-19 may develop later symptoms that need follow-up – some of which may not be apparent, such as cognitive changes, which also require attention from relatives and caregivers.

On the other hand, there are life-threatening consequences of Covid-19 that require emergency care, such as pulmonary embolism, myocardial infarction, arrhythmias, myocarditis, heart failure, stroke, seizures and encephalitis, the WHO adds.

The consequences for the lungs and heart

An article reviewing scientific research on the topic, published in March in the journal Nature, showed that in several parts of the world, shortness of breath was reported on average in 30% of patients followed in the months following the acute phase.

The World Health Organization itself has a handbook (in English) with exercises for the same people who may suffer from shortness of breath at home.

But when these techniques do not solve the problem and there are signs such as unbearable shortness of breath and fainting, it is time to seek medical help.

“When a person recovers at home, but feels discomfort during daily activities, be it daily activities or exercise, when disproportionate fatigue is noticed, it is important that it be evaluated,” explains Gustavo Prado, a pulmonologist at Alemão Oswaldo Cruz Hospital.

Prado explains that patients with long-term respiratory symptoms usually undergo imaging tests, such as a chest X-ray or CT scan, lung function tests, such as spirometry, and physical performance assessment, such as a gait exercise test.

These tests can also help detect pulmonary fibrosis, which is a chronic complication of the most dangerous organ for covid-19, according to a pulmonologist – the other is hypoxemia, which is a decrease in oxygenation caused by problems with gas exchange in the pulmonary alveoli, where The oxygen in the air is captured by the blood and carbon dioxide is released.

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“In patients with more extensive pulmonary involvement, gas exchange is reduced, and the likelihood of progression to fibrosis is greater. Fibrosis is the chronic change in the scar-ridden lung, where there has been inflammation before. The scar is stabilized, tissue function decreases, and it becomes stiffer. And they don’t usually function, “Prado explains.

“It is unusual for people to see fibrosis in people with mild cases. It will be more pronounced in patients with severe forms, prolonged hospitalization, and usually requires oxygen use and even intubation and mechanical ventilation during hospitalization. Fibrosis is unlikely to appear. Late. As a surprise, it is usually a progressive condition that arises from the first lung attack due to infection. “

The heart is also one of the targets of the Coronavirus, especially in severe cases in the acute stage, and as a continuous consequence it can lead to shortness of breath, as it occurs in lung problems – coincidences that show importance for medical advice.

“It is very difficult for the patient himself to determine whether the difficulty in performing a particular effort, or an activity he used to do without any compromise, is the result of respiratory failure, muscle weakness, or a cardiovascular problem,” Prado example.

According to the article published in Nature, other persistent symptoms of covid-19 in the heart are palpitations and chest pain, which may indicate long-term sequelae, such as myocardial fibrosis, arrhythmias, and myocarditis, in addition to medical advice. , By means of exams such as echocardiogram and electrocardiogram.

Effects on the brain

A sick woman wearing a mask

Getty Images
Fatigue, headache, and depression are among the problems most often reported due to your infection with covid-19, even weeks or months after the infection.

“It appears that nearly every area of ​​neuroscience has impacts, and the range of symptoms is very broad,” says Clarissa Yasuda, MD, a professor in the Department of Neurology at Campinas State University (UNECAMB).

She and a team of university researchers are tracking the brain consequences of people who have contracted the Covid-19 virus in the Neuro-Covid survey. There is an online survey open for people to contribute to research.

In October 2020, the team published a preprint study (without the so-called peer review, a standard stage in which other experts analyze a study and decide whether or not to publish in a scientific journal) with data on 81 people. Who were infected with mild Covid-19 virus and recovered.

They underwent MRI scans, questionnaires, and cognitive tests, which showed that, on average 60 days after the diagnosis of COVID-19, patients still had headaches (40%), fatigue (40%), poor memory (30%), and anxiety ( 28%), depression (20%), and loss of smell (28%) and taste (16%) among others.

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“There are many manifestations. A person should be alert if things are not the same before the injury – in sleep, in memories, in performing daily activities, if there is a headache, or hypersensitivity, or altered senses … As symptoms persist, I suggest searching for a neurologist, “Yasuda recommends.

The doctor explains that tests such as an MRI, which are administered to volunteers, can help with the diagnosis. But not always.

Most of the more subtle neurological disorders, which affect daily life – memory, changes in sleep … -, do not lead to changes in an MRI scan. Will blood draw and an MRI scan resolve? Often not. If the problem persists , Nervousness, the person should be examined and interviewed by a neurologist. “

In its recommendations on the medium and long-term neuropsychological effects of the Covid-19 virus, the World Health Organization proposes the application of questionnaires approved by scientists, such as the Montreal Cognitive Assessment and the Scale of Hospital Anxiety and Depression.

According to Yasuda, some questionnaires are applied by default by the doctor, while others can be performed by the patient himself. In any case, remember that such assessments are more than a tool and not a definitive diagnosis – this is the role of the doctor, who arrives at such a conclusion by combining information from questionnaires, examinations and consultations face-to-face and the patient. Date.

In contrast to the ongoing effects on the heart and lungs, the professor at Unicamp says the consequences for the brain are noteworthy because they affect many people who have contracted mild Covid-19 virus.

“Since January, thousands of people have answered our application form. Now, every day more and more people are showing up with neurological complaints. It’s very sad. The biggest impact on that will be these people coming back to work. The result will be.” Tremendous, “he says, referring to the difficulties of concentration, well-being and memory, among other things, with which thousands of people already live, and many of them will, in the post-Coronavirus period.

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